NURSING CARE PLAN

ASSESSMENT NURSING PLANNING INTTERVENTION RATIONALE EVALUATION

DIAGNOSIS
“I was watching TV Acute pain related to The patient will be Assess the client’s Clients with gastric Done. The patient
when my chest increased gastric acid able to lessen gastric pain, including the ulcer typically was able to tell the
started to hurt” as secretion as acid secretion by location, demonstrate pain 1 location,
verbalized by the evidenced by “I was using characteristics, to 2 hours after characteristics
patient watching TV when pharmacological and precipitating factors, eating. The client precipitating factors,
my chest started to nonpharmacological onset, duration, with duodenal ulcers onset, duration,
hurt” as verbalized measures frequency, quality, demonstrates pain 2 frequency, quality,
by the patient intensity, and severity to 4 hours after intensity, and
eating or in the severity
middle of the night.
With both gastric
and duodenal ulcers,
the pain is located in
the upper abdomen
Pain scale of 7/10 and is intermittent.
Epigastric chest pain
Heartburn
Burping The patient will Encourage the use of Nonpharmacological Done. The patient
Facial grimace report satisfactory nonpharmacological relaxation was able to perform
Restlessness pain control at a pain relief measures techniques will nonpharmacological
level less than 2 to 4 such as acupressure, decrease the techniques such as
on a scale of 0 to 10 biofeedback, production of gastric acupressure,
distraction, guided acid, which in turn biofeedback,
imagery, massage, will reduce pain distraction, guided
music therapy and imagery, massage,
deep breathing music therapy and
exercises deep breathing
exercises resulting to
pain reduction

Instruct the client to These medications

avoid NSAIDs such as may cause irritation
aspirin of the gastric mucosa Done. The patient
was able to avoid
Instruct the client that An irregular schedule NSAIDs
meals should be eaten of meals may
regularly paced interfere with the Done. The patient
intervals in a relaxed regular was able to eat
setting administration of regularly paced
medications intervals in a relaxed
setting

Administer Omeprazole is a
combination drugs of proton pump
omeprazole, inhibitor. It Done. The patient
amoxicillin and suppresses gastric was able to take
clarithromycin as basal and stimulated medications and
prescribed by the acid secretion. reduce pain from the
physician Clarithromycin scale of 7/10 to 2/10
prevents bacteria
from multiplying by
acting as a protein
synthesis inhibitor.
Amoxicillin acts by
binding to penicillin-
binding proteins that
inhibit a process
called
transpeptidation,
leading to activation
of autolytic enzymes
in the bacterial cell
wall.
 ASSESSMENT NURSING PLANNING INTTERVENTION RATIONALE EVALUATION
DIAGNOSIS
“I have anxiety due Anxiety related to The patient will be Assess client’s level of Clients with peptic Done. the patient
to what I am feeling, nature of the disease able to have anxiety. ulcers are anxious, was able to show
due to my chest pain as evidenced by “I knowledge about the but their anxiety level of anxiety
and burping” as have anxiety due to nature of the disease level is not visible.
verbalized by the what I am feeling,
patient due to my chest pain Encourage to express Open Done. the patient
and burping” as fears openly communication was able to express
verbalized by the enables the client to fears openly
patient develop a trusting
relationship that aids
in reducing anxiety
and stress.

Shaking
Confuse
Restlessness Educate the patient To have knowledge Done. the patient
about the nature of about the disease was able to
the disease, its process and eventually determine the
and how it affects the understand, to nature of the
body reduce anxiety disease, its process
and how it affects
the body

The patient will be Assist the client in Learning these Done. the patient
able to demonstrate developing anxiety- methods provides was able to
ways of reducing reducing measures the client with a demonstrate
anxiety level. such as biofeedback, variety of ways to measures to reduce
positive imagery, and manage anxiety. anxiety
behavior modification.

Provide emotional Providing emotional Done. the patient

support to client. support will give a was able to reduce
 client calming and anxiety by having
relaxing mood that emotional support
will lower anxiety,
and stress related to
the condition.

Use simple language When experiencing Done. the patient

and brief statements moderate to severe was able to
when giving anxiety, clients may understand simple
instructions to the be unable to and brief statements
client. comprehend
anything more than
simple, clear, and
brief instructions.
 DRUG STUDY
GENERIC INDICATIONS ACTION ADVERSE INTERACTIONS CONTRAINDICATION PATIENT NURSING
NAME REACTIONS S TEACHINGS IMPLICATIONS

Amoxicillin Helicobacter Inhibits cell- Seizures, Drug to drug: Hypersensitive to Take entire If large doses
pylori wall synthesis anxiety, Hormonal drugs, allergic to quantity of are given or if
eradication to during confusion, contraceptives, drugs, drug exactly therapy is
reduce risk of bacterial agitation, live virus as prolonged,
duodenal multiplication dizziness, vaccines, prescribed, bacterial or
ulcer reversible methotrexate, even after fungal
recurrence hypersensitivity, probenecid feeling superinfection
diarrhea, better may occur
nausea, Drug to herb:
vomiting, Khat Take drugs CDAD, ranging
BRAND interstitial with or from mild
NAME nephritis, without diarrhea to
Amox, anemia, food, except fatal colitis has
Amoxil, eosinophilia extended- been reported.
Larotid, Apo- release Evaluate
Amxi tablets patient if
which are diarrhea
taken with occurs
meal
Don’t confuse
Swallow amoxicillin
extended- with
release amoxaphine
DOSAGE, tablets
ROUTE & whole and
FREQUENCY not to chew,
crush or spit
1000 mg, them
 P.O., q12
hours Notify
physician if
rash, fever
or chills
develop

GENERIC INDICATION ACTION ADVERSE INTERACTIONS CONTRAINDICATIO PATIENT NURSING

NAME S REACTIONS NS TEACHINGS IMPLICATIONS

Clarithromyci Used in A Diarrhea, Drug: May Hypersensitivity to Complete Inquire about

n combination semisyntheti abdominal increase clarithromycin, prescribed previous
for c macrolide discomfort, theophylline erythromycin, or course of hypersensitivity to
Helicobacter antibiotic nausea, levels; drugs any other macrolide therapy. other macrolides
pylori. that binds to abnormal known to interact antibiotics; patients (e.g.,
the 50S taste, with erythromycin receiving pimozide; Report rash or erythromycin)
ribosomal dyspepsia. (i.e., digoxin, suspected or other signs of before treatment.
subunit of Eosinophili carbamazepine, potential hypersensitivit
susceptible a. triazolam, bacteremias; acute y immediately. Withhold drug and
bacterial Headache. warfarin, porphyria; severe notify physician, if
BRAND organisms Rash, ergotamine, hepatic or biliary Report loose hypersensitivity
NAME and thus urticaria. dihydroergotamin disease; pregnancy stools or occurs (e.g., rash,
inhibits e) should be (category C). Safety diarrhea even urticaria).
Biaxin protein monitored and efficacy in after
synthesis of carefully for children <6 y not completion of Monitor for and
the bacteria. increased levels established. drug therapy. report loose stools
and toxicity; or diarrhea, since
 pimozide may Do not breast pseudomembrano
DOSAGE, increase risk of feed without us colitis must be
ROUTE & arrhythmias. consulting ruled out.
FREQUENCY physician.
500 mg, P.O., When
b.i.d. to t.i.d. clarithromycin is
given concurrently
with
anticoagulants,
digoxin, or
theophylline, blood
levels of these
drugs may be
elevated. Monitor
appropriate serum
levels and assess
for S&S of drug
toxicity.

GENERIC INDICATIONS ACTION ADVERSE INTERACTIONS CONTRAINDICATION PATIENT NURSING

 NAME REACTIONS S TEACHINGS IMPLICATIONS

Omeprazole Duodenal and An Headache, Drug: Long-term use for Report any Lab tests:
gastric ulcer. antisecretory dizziness, Concomitant gastroesophageal changes in Monitor
Gastroesophageal compound fatigue. administration reflux disease (GERD), urinary urinalysis for
reflux disease that is a Diarrhea, of diazepam duodenal ulcers; elimination hematuria and
including severe gastric acid abdominal and proton pump such as pain proteinuria.
erosive pump pain, omeprazole inhibitors (PPIs), or discomfort Periodic liver
esophagitis (4 to inhibitor. nausea, mild may increase hypersensitivity. associated function tests
8 wk treatment). Suppresses transient diazepam with with
In combination gastric acid increases in concentrations. urination, or prolonged use.
BRAND with secretion by liver Concomitant blood in
NAME clarithromycin to inhibiting the function administration urine.
treat duodenal H+, K+- tests. of phenytoin
Losec ulcers associated ATPase Hematuria, and Report severe
with Helicobacter enzyme proteinuria. omeprazole diarrhea;
pylori. system [the Rash. may increase drug may
acid (proton phenytoin need to be
H+) pump] in levels. discontinued.
the parietal Concomitant
cells. administration Do not breast
of warfarin and feed while
omeprazole taking this
DOSAGE, may increase drug.
ROUTE & warfarin levels.
FREQUENCY

PO 40 mg
once/d
 GENERIC INDICATION ACTION ADVERSE INTERACTIONS CONTRAINDICATION PATIENT NURSING
NAME S REACTIONS S TEACHINGS IMPLICATIONS
Discontinue Monitor for loss
Aspirin To relieve Major actions Body as a Whole: Drug: History of aspirin use of tolerance to
pain of low appear to be Hypersensitivity Aminosalicylic hypersensitivity to with onset aspirin. The
to moderate associated (urticaria, acid increases salicylates including of ringing or reaction is
intensity. primarily with bronchospasm, risk of methyl salicylate (oil buzzing in nonimmunologi
Also, for inhibiting the anaphylactic SALICYLATE of wintergreen); the ears, c; symptoms
various formation of shock (laryngeal toxicity. sensitivity to other impaired usually occur 15
inflammator prostaglandins edema). CNS: Ammonium NSAIDs; patients hearing, min to 3 h after
y conditions, involved in the Dizziness, chloride and with "aspirin triad" dizziness, GI ingestion:
such as production of confusion, other (aspirin sensitivity, discomfort profuse
BRAND acute inflammation, drowsiness. ACIDIFYING nasal polyps, or bleeding, rhinorrhea,
NAME rheumatic pain, and fever. Special Senses: AGENTS asthma); chronic and report erythema,
fever, Antiinflammato Tinnitus, hearing decrease renal rhinitis; chronic to nausea,
Alka- Systemic ry action: loss. GI: Nausea, elimination and urticaria; history of physician. vomiting,
Seltzer, Lupus, Inhibits vomiting, increase risk of GI ulceration, intestinal
A.S.A., rheumatoid prostaglandin diarrhea, SALICYLATE bleeding, or other Do not use cramps,
Aspergum, arthritis, synthesis. As an anorexia, toxicity. problems; aspirin for diarrhea.
Astrin osteoarthriti antiinflammato heartburn, ANTICOAGULAN hypoprothrombinem self-
s, bursitis, ry agent, aspirin stomach pains, TS increase risk ia, vitamin K medication Lab tests:
and calcific appears to be ulceration, occult of bleeding. deficiency, of pain frequent PT and
tendonitis, involved in bleeding, GI ORAL hemophilia, or other (adults) IRN with
and to enhancing bleeding. HYPOGLYCEMIC bleeding disorders; beyond 5 d concurrent
reduce fever antigen Hematologic: AGENTS increase without anticoagulant
DOSAGE, in selected removal and in Thrombocytopeni hypoglycemic consulting a therapy; more
ROUTE & febrile reducing the a, hemolytic activity with physician. frequent fasting
FREQUENC conditions. spread of anemia, aspirin doses >2 Do not use blood glucose
Y Used to inflammation in prolonged g/d. CARBONIC aspirin levels with
reduce ground bleeding time. ANHYDRASE longer than diabetes.
PO/PR recurrence substances. Skin: Petechiae, INHIBITORS 3 d for
350–650 of TIA due to These easy bruising, enhance fever Monitor for
mg q4h fibrin antiinflammato rash. Urogenital: SALICYLATE (adults and salicylate
(max: 4 platelet ry actions also Impaired renal toxicity. children), toxicity. In
g/d) emboli and contribute to function. Other: CORTICOSTEROI adults, a
risk of stroke analgesic Prolonged DS add to never for sensation of
in men; to effects. pregnancy and ulcerogenic fever over fullness in the
prevent labor with effects. 38.9° C ears, tinnitus,
recurrence increased Methotrexate (102° F) in and decreased
of MI; as bleeding. toxicity is older adults or muffled
prophylaxis increased. Low or 39.5° C hearing are the
against MI in doses of (103° F) in most frequent
men with SALICYLATES children symptoms
unstable may antagonize and adults associated with
angina. uricosuric effects under 60 chronic
of probenecid yrs or for salicylate
and recurrent overdosage.
sulfinpyrazone. fever
Herbal: without Note: Potential
Feverfew, garlic, medical for toxicity is
ginger, ginkgo direction. high in older
may increase adults and
bleeding Consult patients with
potential. physician asthma, nasal
before polyps,
using perennial
aspirin for vasomotor
any fever rhinitis, hay
accompanie fever, or
d by rash, chronic
severe urticaria
headache,
stiff neck,
marked
irritability,
or
confusion
(all possible
symptoms
of
meningitis).

Avoid
alcohol
when
taking large
doses of
aspirin.

Observe
and report
signs of
bleeding
(e.g.,
petechiae,
ecchymoses
, bleeding
gums,
bloody or
black
stools,
cloudy or
bloody
urine).

Maintain
adequate
fluid intake
when
taking
repeated
doses of
aspirin.

Avoid other
medications
containing
aspirin
unless
directed by
physician,
because of
danger of
overdosing
(there are
more than
500 OTC
aspirin-
containing
compounds
).
 GENERIC INDICATIONS ACTION ADVERSE INTERACTIONS CONTRAINDICATIO PATIENT NURSING
NAME REACTIONS NS TEACHINGS IMPLICATIONS

Ibuprofen Chronic, Prototype of CNS: Headache, Drug: ORAL Patient in whom

symptomatic the propionic dizziness, light- ANTICOAGULANT urticaria, severe Notify Monitor for
rheumatoid acid NSAIDs headedness, S, heparin may rhinitis, physician therapeutic
arthritis and (cox-1) anxiety, prolong bleeding bronchospasm, immediately effectiveness.
osteoarthritis inhibitor with emotional time; may angioedema, nasal of passage Optimum
; relief of nonsteroidal lability, fatigue, increase lithium polyps are of dark tarry response
mild to antiinflammato malaise, and precipitated by stools, generally
moderate ry activity and drowsiness, methotrexate aspirin or other "coffee occurs within 2
pain; primary significant anxiety, toxicity. Herbal: NSAIDs; active ground" wk (e.g., relief
BRAND dysmenorrhe antipyretic and confusion, Feverfew, garlic, peptic ulcer, emesis, of pain,
NAME a; reduction analgesic depression, ginger, ginkgo bleeding frankly stiffness, or
of fever. properties. aseptic may increase abnormalities. bloody swelling; or
Advil, Blocks meningitis. CV: bleeding emesis, or improved joint
Amersol prostaglandin Hypertension, potential. other GI flexion and
synthesis. palpitation, distress, as strength).
Ibuprofen congestive heart well as
activity also failure (patient blood or Observe
includes with marginal protein in patients with
modulation of cardiac function); urine, and history of
DOSAGE, T-cell function, peripheral onset of skin cardiac
ROUTE & inhibition of edema. Special rash, decompensati
FREQUENC inflammatory Senses: pruritus, on closely for
Y cell Amblyopia jaundice. evidence of
chemotaxis, (blurred vision, fluid retention
PO 400– decreased decreased visual Do not drive and edema.
800 mg release of acuity, scotomas, or engage in
t.i.d. or superoxide changes in color other Lab tests:
q.i.d. (max: radicals, or vision); potentially Baseline and
3200 increased nystagmus, hazardous periodic
mg/d) scavenging of visual-field activities evaluations of
these defects; tinnitus, until Hgb, renal and
compounds at impaired hearing.
inflammatory GI: Dry mouth, response to hepatic
sites. gingival the drug is function, and
ulcerations, known. auditory and
dyspepsia, ophthalmologi
heartburn, Do not self- c examinations
nausea, vomiting, medicate are
anorexia, with recommended
diarrhea, ibuprofen if in patients
constipation, taking receiving
bloating, prescribed prolonged or
flatulence, drugs or high-dose
epigastric or being therapy.
abdominal treated for a
discomfort or serious Monitor
pain, GI condition for GI
ulceration, occult without distress
blood loss. consulting and S&S of
Hematologic: physician. GI
Thrombocytopeni bleeding.
a, neutropenia, Do not give
hemolytic or to children Note:
aplastic anemia, younger Symptoms of
leukopenia; than 3 mo or acute toxicity
decreased Hgb, for longer in children
Hct; transitory than 2 d include apnea,
rise in AST, ALT, without cyanosis,
serum alkaline consulting response only
phosphatase; rise physician. to painful
in (Ivy) bleeding stimuli,
time. GU: Acute Do not take dizziness, and
renal failure, aspirin nystagmus.
polyuria, concurrently
azotemia, cystitis, with
hematuria,
nephrotoxicity, ibuprofen.
decreased
creatinine Avoid
clearance. Skin: alcohol
Maculopapular and NSAIDs
and vesicobullous unless
skin eruptions, otherwise
erythema advised by
multiforme, physician.
pruritus, rectal Concurrent
itching, acne. use may
Body as a Whole: increase risk
Fluid retention of GI
with edema, ulceration
Stevens-Johnson and bleeding
syndrome, toxic tendencies.
hepatitis,
hypersensitivity Do not
reactions, breast
anaphylaxis, feed
bronchospasm, while
serum sickness, taking
SLE, angioedema. this drug
without
consulti
ng
physicia
n.
GENERIC INDICATIONS ACTION ADVERSE INTERACTIONS CONTRAINDICATIO PATIENT NURSING
NAME REACTIONS NS TEACHINGS IMPLICATIONS

Naproxen Antiinflammat Propionic CNS: Headache, Drug: Bleeding Active peptic ulcer:
sodium ory and acid drowsiness, time effects of patients in whom Be aware Take detailed drug
analgesic derivative. dizziness, ORAL asthma, rhinitis, that the history prior to
effects in NSAID with lightheadedness, ANTICOAGULAN urticaria, therapeutic initiation of therapy.
symptomatic properties depression. CV: TS, heparin may bronchospasm, or effect of Observe for signs of
treatment of similar to Palpitation, be prolonged; shock is naproxen allergic response in
acute and those of dyspnea, may increase precipitated by may not be those with aspirin or
chronic other peripheral lithium toxicity. aspirin or other experienced other NSAID sensitiv
rheumatoid propionic edema, CHF, Herbal: NSAIDs. for 3–4 wk. ity.
arthritis, acid tachycardia. Feverfew, garlic,
BRAND juvenile derivatives, Special Senses: ginger, ginkgo Do not Lab tests: Obtain
NAME arthritis e.g., Blurred vision, may increase drive or baseline and
(naproxen ibuprofen, tinnitus, hearing bleeding engage in periodic evaluations
Aleve, only), and for fenoprofen, loss. GI: potential. potentially of Hgb and kidney
Anaprox, treatment of ketoprofen. Anorexia, hazardous and liver function in
Anaprox primary Mechanism heartburn, activities patients receiving
DS dysmenorrhea. of action indigestion, until prolonged or high
Also thought to nausea, response to dose therapy.
management be related vomiting, thirst, drug is
of ankylosing to GI bleeding, known. Schedule baseline
spondylitis, inhibition elevated serum and periodic
osteoarthritis, of ALT, AST. Avoid auditory and
DOSAGE, and gout. prostagland Hematologic: alcohol and ophthalmic
ROUTE & in Thrombocytope aspirin (as examinations in
FREQUEN synthesis. nia, leukopenia, well as patients receiving
CY eosinophilia, other NSAID prolonged or high
inhibited platelet s) unless dose therapy.
PO 250– aggregation, otherwise
500 mg agranulocytosis advised by a Monitor therapeutic
b.i.d. (rare). Skin:
 (max: Pruritus, rash,
1000 ecchymosis. physician. effectiveness.
mg/d Urogenital: Potential to Patients with
naproxen, Nephrotoxicity. increase arthritis may
1100 Respiratory: risk of GI experience
mg/d Pulmonary ulceration symptomatic relief
naproxen edema. and (reduction in joint
sodium) bleeding. pain, swelling,
stiffness) within 24–
Tell your 48 h with naproxen
dentist or sodium therapy and
surgeon if in 2–4 wk with
you are naproxen.
taking
naproxen
before any
treatment;
it may
prolong
bleeding
time.

Do not
breast feed
while taking
this drug
without
consulting
physician.